Long-term survival in patients with human immunodeficiency virus-associated small non-cleaved cell lymphoma: the role for short course intensive chemotherapy

AIDS-associated Burkitt or Burkitt-like lymphoma: Short intensive polychemotherapy is feasible and effective

The objective was to evaluate the feasibility and efficacy of a short-term, multi-agent and dose intensive regimen in AIDS patients with Burkitt or Burkitt-like lymphoma (BL/BLL) and to compare its efficacy with that of a conventional regimen. This was a retrospective, multi-center cohort study of all HIV-1-infected patients diagnosed with BL/BLL between 1990 - 2004. Patients were assigned to two different chemotherapy approaches. Group A received a protocol which was adapted from the German multi-center study group for adult acute lymphoblastic leukemia (GMALL). Group B received a conventional CHOP-based chemotherapy. Fifty-one patients were included in the analysis. In group A (n = 20), significantly more patients achieved complete remission (75% vs 40%, P = 0.02) than in group B (n = 31). One-year survival in group A was 65% compared to 44% in group B (P = 0.17). In a multi-variable Cox regression analysis, treatment according to the GMALL protocol was significantly associated with prolonged survival with a relative hazard rate of 0.13 (95% CI 0.03 - 0.63, P = 0.01). In conclusion, the short and intensive GMALL protocol for B-ALL/NHL is feasible in patients with AIDS-BL/BLL. Outcome may be improved compared to patients treated with CHOP-based regimens. In the era of HAART, more intensive chemotherapy regimens should be considered in patients with highly aggressive lymphomas.

Improving outcomes for patients with Burkitt lymphoma and HIV

Burkitt lymphoma (BL) is a highly aggressive B-cell malignancy that occurs with increased frequency among patients infected with HIV. Until recently, the immunocompromised state of patients with HIV and BL was generally deemed to preclude the use of the intensive chemotherapeutic regimens used to treat HIV-negative patients due to toxicity issues. However, the advent of highly active antiretroviral therapy (HAART) and the mounting evidence that less intensive lymphoma regimens are ineffective in BL have led investigators to treat HIV-positive patients with the same chemotherapy now established as the standard of care for immunocompetent patients. Data suggest that these current approaches, along with supportive care, may result in improved patient outcomes. In contrast, the role of adjunctive immunotherapy with rituximab in HIV-BL remains undefined. Further studies, including randomized clinical trials, are needed to better delineate the optimal treatment for patients with this devastating disease.

Update in HIV-associated lymphoma

PURPOSE OF REVIEW

Infection with human immunodeficiency virus (HIV) is associated with an increased risk of non-Hodgkin lymphoma and Hodgkin disease. This review summarizes developments within the past 18 months.

RECENT FINDINGS

Investigators continue to demonstrate that many standard therapies similar to those used in the non-HIV- infected population may be used in the HAART era for patients infected with HIV. Biologic differences do exist, however, and not all treatments and outcomes are directly translatable. Some treatments, such as rituximab in combination with CHOP, may have unforeseen toxicity. Nonetheless, high-dose therapy does appear feasible and may offer curative therapy for those with refractory and relapsed disease.

SUMMARY

HIV-infected persons appear to benefit from most, but not all standard treatments for lymphoma.